| Provider Type: | Other Service Providers |
| Provider Classification: | Specialist |
| Definition of Specialization: | |
| Address: |
2303 Ira E Woods Ave Grapevine, TX 76051-3926 |
| Phone: | (817) 488-0885 |
| Fax: | (817) 424-1234 |
| Gender: | Male |
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